Treatment of Body Image Dissatisfaction Among Women With Bulimia Nervosa

Body image dissatisfaction contributes to the development and maintenance of bulimia nervosa. Many women with bulimia are unhappy with their body's appearance and yearn to attain the thin shape glamorized by our culture. This obsession breeds low self-esteem, feelings of inadequacy, and resistance to recovery from bulimia. This article offers treatment suggestions for body image dissatisfaction as it relates to bulimia. Counselors must be comfortable with their own bodies and must be cognizant of sociocultural dictates demanding a thin body for women.     

Bulimia: Cognitive-Behavioral Treatment and Relapse Prevention

The authors review the assumptions about processes that maintain bulimic behavior. Specific treatment package recommendations are made on the basis of selected outcome literature. Special issues, such as Axis II diagnosis, hospitalization, and psychopharmaceutics, are addressed.     

Microaggressions and Sexual Risk Behaviors in Black College Women: A Moderated Mediation Analysis

The study examined the association between microaggressions and sexual risk behaviors, the mediating role of anxiety, and the moderation of this mediation by bicultural self‐efficacy. One hundred twenty‐six Black college women (mean age = 20.63) completed a survey. A moderated mediation analysis showed that anxiety partially mediated the relationship between microaggressions and sexual risk behaviors and that bicultural self‐efficacy did not significantly moderate the indirect relationship. Findings indicate the importance of microaggressions in psychological and physical health. El estudio examinó la asociación entre microagresiones y comportamientos sexuales de riesgo, el papel mediador de la ansiedad y la moderación de esta mediación la autoeficacia bicultural. Ciento veintiséis mujeres negras universitarias (media de edad = 20.63) completaron una encuesta. Un análisis de mediación moderada mostró que la ansiedad medió parcialmente la relación entre microagresiones y comportamientos sexuales de riesgo, y que la autoeficacia bicultural no moderó la relación indirecta de forma significativa. Los hallazgos indican la importancia de las microagresiones en la salud física y psicológica.     

The Bulimia Workshop: A Unique Integration of Group Treatment Approaches

The time constraints of weekly group therapy and the slow evolution of group cohesion attenuate the direct confrontation that is essential with bulimic patients. Consequently, a three-phase, multidimensional group program was devised to accelerate the treatment process. Treatment begins with an intensive weekend workshop during which members formulate contracts for interrupting the binge–purge cycle and changing symptomatic behavior. During a follow-up session problems in fulfilling the contracts are dealt with and successes are reinforced, in the final phase, group members convene without their therapists to provide peer support, reevaluate contracts, and share feelings regarding treatment progress. The unique implications for treatment process and therapist interventions prompted by this new format are discussed, and preliminary research findings are highlighted.     

A Pilot Study of a Functional Contextual Treatment for Bulimia Nervosa

This paper describes the initial development of a treatment for bulimia nervosa using a functional contextual treatment approach. Seven women (6 with a diagnosis of bulimia nervosa and 1 with a diagnosis of eating disorder not otherwise specified) completed 12 sessions of functional contextual treatment. Participants were assessed with the Eating Disorders Examination at baseline and following treatment. The intervention produced significant reductions in binge eating, purgative behavior, dietary restraint, and eating concerns. A functional contextual treatment holds promise for the treatment of bulimia nervosa. However, the treatment needs to be refined further and will need to be tested in controlled clinical trials with long-term follow-up.     

The Prophylactic Mastectomy Dilemma: A Support Group for Women at High Genetic Risk for Breast Cancer

The goal of this pilot study was to test the usefulness of a six session psychoeducational support group for women at high genetic risk for breast cancer who were considering prophylactic mastectomy. The themes of the group sessions included overestimation of and anxiety about risk; desire for hard data; the emotional impact of watching a mother die of breast cancer; concerns about spouse reactions; self- and body image; the decision-making process; and confusion over whom to trust in decision making. Both the participants and the multidisciplinary leaders concluded that as a supplement to individual counseling, a support group is a beneficial and cost-effective treatment modality. Recommendations for the optimal format for such a group are described.     

Risk Perception Among Women at Risk for Hereditary Breast and Ovarian Cancer

This paper is a summation of selected history and literature on risk perception as it pertains to genetic counseling and testing, with a focus on hereditary breast and ovarian cancer, the area which has seen the greatest focus of research. Risk perception is a complex and incompletely understood concept which seeks to capture the myriad meanings that an individual attaches to the experience of being at increased risk. It is now evident that “risk”, as perceived by the patient, is different from the objective, quantifiable risk estimate often provided to them during genetic counseling. What is also clear is that the complicated set of factors influencing risk perception are not yet well understood, nor are the mechanisms the lead from perceived risk to behavioral change in the patient. In situations where specific behavioral changes such as increased cancer screening are an inherent goal of the genetic risk assessment and counseling process, gaining a better understanding of the specific factors motivating change will be essential.     

Treatment Fidelity of a Randomized Controlled Trial for Suicidal Risk

Treatment fidelity is a crucial consideration within randomized controlled trials (RCTs). The present study relies on data from a feasibility RCT conducted with 62 treatment-seeking suicidal college students. Issues of experimental fidelity were germane in this investigation because the same clinicians provided both the experimental (the Collaborative Assessment and Management of Suicidality—CAMS) and the control (treatment as usual—TAU) care. The first aim of the current study was to determine adherence to the CAMS model within the experimental (CAMS) and control (TAU) treatment conditions. A second exploratory aim was included to examine how treatment fidelity impacted treatment outcomes (i.e., depression, suicidal ideation, hopelessness, and potential treatment moderators). The CAMS Rating Scale (CRS.3-R) was used to determine treatment adherence to the CAMS model and to ensure between-group fidelity within the trial. The CRS.3-R was completed throughout the course of care based on reviews of a selected number of video recordings of both CAMS and TAU sessions to measure treatment fidelity. Mean CRS.3-R scores revealed differences across treatment conditions such that clinicians were successfully able to provide each treatment separately without contamination. Further, higher CRS.3-R scores in CAMS sessions resulted in decreased hopelessness over the treatment period. Higher CRS.3-R scores in TAU sessions resulted in an increased likelihood of suicidal ideation and less reduction in hopelessness over the treatment period. Overall, clinicians can serve as their own controls in a RCT and levels of adherence to the CAMS model have different effects on suicidal ideation and hopelessness.

     

Toward Reducing Risk for Eating Disorders and Obesity in Latina College Women

The efficacy of 2 computer‐based programs was tested with Latina college women (N= 64). Compared with participants in the control group, intervention participants improved their motivation to eat fruits and vegetables (F&V; p= .042) and to participate in physical activity (p= .023) and significantly increased their F&V intake (pre‐ to posttest, p < .001; pre‐follow‐up, p= .002). Body dissatisfaction improved at a trend level (p= .055). Some modest effects of computer‐based programs were found.     

Accept Yourself! A Pilot Randomized Controlled Trial of a Self-Acceptance-Based Treatment for Large-Bodied Women With Depression

A pilot parallel randomized controlled trial compared a self-acceptance, non-weight-loss intervention, Accept Yourself! (AY), to a weight loss program, Weight Watchers (WW), in order to provide preliminary safety, feasibility, and efficacy data in preparation for a definitive RCT of AY as an intervention to enhance the mental and physical health of larger-bodied women with Major Depressive Disorder (MDD). Adult women with MDD and a Body Mass Index ≥30 were eligible. Nineteen women were randomized by random number table into AY (n = 9) or WW (n = 10). Intake, pretreatment, posttreatment, 3-, 6-, 9-, and 12-month follow-up assessments occurred at a rural academic medical center. Primary outcomes included depression severity and cardiovascular fitness. Chi-square and t-tests assessed attrition and participant preferences for treatment; other analyses used intention-to-treat, linear mixed-effects models for repeated measures, including all participants’ available data. Both groups improved in self-reported, F(5, 43.81) = 7.45, p < .001, partial η² = .38, and blinded-clinician-rated depression, F(6, 62.03) = 10.41, p < .001, partial η² = .5. AY was superior to WW in self-reported depression, F(5, 43.81) = 2.72, p = .03, partial η² = .11. Neither group improved in fitness. Eating disorder symptoms and weight gain worsened in WW. AY appeared safe, feasible, and offered initial evidence of efficacy for depression; it should be investigated in a definitive RCT, with modifications to increase potency. WW may not be suitable as a comparator intervention for AY because of risk to participants.     

Bulimia: Treatment of purging via systematic rational restructuring

The purpose of this study was to utilize a cognitive treatment approach to eliminate purging in three high school females     

Breast Cancer Risk Assessment at the Time of Screening Mammography: Perceptions and Clinical Management Outcomes for Women at High Risk

The purpose of this study was to evaluate the utility of a breast cancer risk assessment (BCRA) at the time of screening mammogram. Women whose BCRA indicated a high risk for cancer received a letter with instructions for breast health care and genetic counseling if appropriate. After 6 months this group received surveys to evaluate their risk perception and their recall of, and compliance with, recommendations. We also explored the impact of other variables such as a recommendation for genetic counseling and physician communication with the women. After the BCRA, the majority of high risk women reported no change in their perceived risk of cancer. A woman’s perceived risk of cancer after a BCRA was significantly associated with her recall of recommendations for breast health care, but not with compliance. A recommendation for genetic counseling was not significantly related to women’s perceived risk of cancer after the BCRA. Ten percent of women who should have obtained genetic counseling actually completed an appointment. Women who discussed their BCRA results with their physicians were more compliant with a six month breast exam with a doctor (53% vs 17%, p = 0.018). Overall, women felt that the BCRA was helpful and did not cause undue stress or anxiety. Although the cohort’s compliance with recommendations was suboptimal, physicians’ interactions with their patients may have a positive influence on their compliance.     

Addressing Weight Suppression to Improve Treatment Outcome for Bulimia Nervosa

Cognitive behavioral therapy (CBT) is regarded as the gold-standard treatment for bulimia nervosa (BN), yet despite impressive empirical support for its effectiveness, over 50% of patients fail to achieve abstinence from binge eating and purging by the end of treatment. One factor that may contribute to reduced efficacy rates in CBT is weight suppression (WS; the difference between a person's highest weight ever at their adult height and current weight). A growing body of research indicates that WS in patients with BN may have a clinically significant effect on symptomatology and prognosis. However, the current cognitive behavioral framework for BN does not explicitly acknowledge the role of WS in the onset or maintenance of BN symptoms and does not provide guidance for clinicians on how to address WS during treatment. The relationship between WS, biological pressure to regain lost weight, and the maintenance of BN symptoms suggest that current cognitive behavioral models of BN may be improved by considering the role of WS and exploring needed treatment modifications. Indeed, a reconceptualization of existing models may offer insight into potential strategies that can be used to reduce the susceptibility to treatment dropout, nonresponse, and relapse. It is therefore necessary to consider whether, and how, clinicians' consideration of WS during case conceptualization and treatment planning could serve to improve CBT outcomes. The current review explores ways in which high WS could contribute to poor CBT outcomes, provides preliminary clinical recommendations for incorporating WS into existing cognitive behavioral treatments based on extant data and clinical wisdom, and proposes suggestions for future research needed in this domain.     

A Body Image Resilience Model for First-Year College Women

The purpose of this study was to investigate Choate’s (2005) theoretical model of body image resilience by examining the association among protective factors and body image. First-year college women (N?=?301) from two universities in the United States (one in the South and one in the Northeast) completed questionnaires assessing five protective factors. The hypothesized model fit the data well. As predicted, high family support; low levels of perceived sociocultural pressure from family, friends, and media regarding the importance of achieving a thin-and beautiful ideal; rejection of the superwoman ideal; positive physical self-concept; and active coping skills contributed to a woman’s overall wellness, which was associated with a more positive body image. Results can inform prevention for young women at risk for eating disorders and suggest specific counseling interventions to improve body dissatisfaction and initial maladaptive eating practices.     

Young Women at Risk for Eating Disorders: Perceived Family Dysfunction and Parental Psychological Problems

These results of this study are consistent with theories of eating disorders that highlight the role of family factors in the etiology and maintenance of eating disorders. When 27 young women at risk for eating disorders who scored above the clinical cut-off score on the EDI-II were compared with age and SES matched controls, they were found to obtain more dysfunctional scores on the Family Assessment Device and on ratings of perceived maternal and paternal symptomatology on the SCL-90-R.     

Learning at Workstations in the Zoo: A Controlled Evaluation of Cognitive and Affective Outcomes

ABSTRACT

This study aimed to test the cognitive and affective benefits gained through the provision of educational materials at workstations in the Wilhelma Zoo in Stuttgart, Germany. Structured learning materials were developed for use with visiting school groups. The materials focused on the adaptations of 6 selected groups of bird species and were organized as a self-guided learning environment (workstations). The value of the materials was assessed in terms of cognitive (learning and retention) and emotional (interest, well-being, boredom, anxiety, contentedness) variables. The authors measured prior knowledge (1 week before the zoo visit), learning effect (1 week after the visit), and retention (8 to 9 weeks later). A total of 103 students (6th graders aged between 11–12 years) participated in the study, 77 receiving a treatment about adaptations in bird species and 26 receiving a treatment about reptiles which served as a control. Students had similar prior knowledge, but 1 week later students receiving the bird unit scored significantly better and this persisted into retention. Girls achieved higher scores than boys, both 1 week and 8 to 9 weeks after the visit. Surprisingly, students in the control group reported higher interest, well-being and contentedness, and lower boredom than those in the treatment group.     

The Academic Interests of College Women: A Factorial Study

The extent to which college programs meet the needs and goals of women students has not been established. In this study, a sample of students and alumnae of the College of Home Economics, Iowa State University, responded to a set of attitude scales concerning their reactions to courses in their core curriculum. Factor analysis of the person-course interactions revealed 6 factors which were tentatively defined in terms of the courses loading most heavily on each. Implications for improved educational planning of women are discussed.